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Take a Deep Breath: Supplemental Oxygen Therapy for COPD

If you’ve been diagnosed with chronic obstructive pulmonary disease, COPD, you may think that dragging around an oxygen canister is just that, a drag. But that extra oxygen is just what your body needs to prevent the damage caused by oxygen deficiency. When used regularly, supplemental oxygen therapy has been shown to improve both the quality and length of life for those who suffer from severe COPD.

In fact, patients can still reap the benefits of extra oxygen even if they have less severe forms of COPD. And all patients can benefit from respiratory therapy to help them breathe better. Be aware, however, that you should consult your physician before using supplemental oxygen since long-term use of high concentration oxygen can have dangerous effects. Gretchen Lawrence, RRT, program associate for the National Lung Health Education Program and fellow of the American Association for Respiratory Care, explains how a little bit of oxygen can provide big relief.

What is COPD?
COPD, [which includes chronic bronchitis and emphysema] is a disease that is characterized primarily by an inability to get air out of the lungs. Symptoms include chronic cough, excess mucous and exercise-related dyspnea [difficulty breathing]. The lungs lose their elastic recoil and, therefore, the patients find it hard to get air out. It’s the nation’s most rapidly growing health problem-ranking fourth among the most common causes of death in the United States. Unfortunately, it’s on the rise. Most of the people who have COPD (about 85 percent) have a history of smoking or inhalation of tobacco substances.

How is COPD diagnosed?
There are a lot of reasons that people might be short of breath or have mucous production, so you want to be clear that you’re dealing with COPD. COPD is diagnosed through the use of spirometry, a simple breathing test that measures airflow out of the lungs. If the forced expiratory volume [the amount of air you breathe out] is reduced, you have a classic diagnosis of COPD.

How is COPD treated?
If the patient is a smoker, they should quit smoking. Additionally, there are certain medications that are appropriate to help with the symptoms. Classically, we use bronchodilators, which are inhaled to help open the airways. Corticosteroids are also given to help reduce the inflammation of the airway.

Infection in the lungs is a challenge in treating COPD, because if a patient gets an infection, they get bronchitis. [Infection is common in COPD patients, as the lung’s normal defense mechanisms are reduced.] Bronchitis is a sign that COPD is getting worse, and will further affect a patient’s breathing. Antibiotics are used as needed to prevent infection. Other treatments, including supplemental oxygen, pulmonary rehabilitation and patient education, are also helpful.

What is supplemental oxygen therapy?
Because the inflammation of COPD destroys tissue in the lungs, the transportation of oxygen to the cells of the lungs and the transportation of carbon dioxide back out of the cells are reduced. This causes hypoxemia or low blood oxygen levels. Pulmonary hypertension may result, as the inflammation makes it harder for blood to get into the lungs, further lowering the amount of oxygen in the blood. This causes shortness of breath, fatigue and dizziness.

When people need supplemental oxygen, it’s usually delivered via a pressurized tank, a liquid system or a concentrator, which contain 95 percent oxygen. [Normal air contains about 20 percent oxygen]. All these systems make the oxygen available for use by the patient through a low-flow mechanism. A flexible tube called a nasal canula is placed in their nostrils to ensure that they get more oxygen in every breath.

How do you know when a person needs supplemental oxygen therapy?
Usually, if you’re short of breath doing simple activities-such as bathing, dressing, fixing meals-you need to have your blood oxygen level tested. One way to do that is with a device called an oximeter. [An oximeter shines light through your finger and measures the amount of light absorbed by the oxygen carrying hemoglobin in red blood cells. By calculating the amount of light absorption, the device can measure the percent of hemoglobin that has oxygen to that which does not.] An oxygenation level below 88 percent indicates that the person needs supplemental oxygen.

The other way that you test the blood oxygen level is through an invasive procedure that uses a blood gas syringe to draw blood out of an artery. The blood is then sent through an analyzer to look at the level of oxygen.

How does oxygen therapy help improve patients’ lives?
If a patient doesn’t get supplemental oxygen, then that affects all the organs of the body, primarily their brain, heart and kidneys. The oxygen helps them live an independent life. We know, from the Nocturnal Oxygen Therapy Trial (NOTT), a study sponsored by the National Heart Lung and Blood Institute that compared 24 hour supplemental oxygen therapy to 12 hour oxygen therapy, that if a patient who needs oxygen takes it for at least fifteen hours a day, there’s an improvement in survival and quality of life.

How often does a person with COPD need to use supplemental oxygen?
Fifteen hours out of the day has been established by the NOTT trials as being the most effective. A person uses it when they’re up and around during the day, and they use it to sleep at night. A lot of times people say, "Well, if I’m going to have it on fifteen hours, I might as well have it on 24." And that, quite honestly, is often how things happen.

For those people who are kind of on the cusp of needing supplemental oxygen, their oxygen level may only drop when they’re sleeping. The NOTT study showed that if you can have people on supplemental oxygen while they sleep, you don’t have this rise and fall of the oxygen level that can be damaging, or at least very taxing, to the heart and brain. If you are a patient who’s on the cusp, and you’re getting up on a treadmill and exercising, that problem of moving air in and out of the lungs gets exacerbated a little bit and those people will have their oxygen level drop. So some people have supplemental oxygen for exercising, too.

The other issue is if you live somewhere along the coast of the United States, or in flatlands where elevation from sea level is very low and the air is "thicker." it’s easier to get enough oxygen. So if somebody with COPD who goes without supplemental oxygen in, say, Dallas, Texas goes to Denver, Colorado, where the air is thinner, there are fewer oxygen molecules in every breath and that patient likely will need to use supplemental oxygen for their trip.

What other types of therapy are recommended for people with COPD?
The whole goal is to return the patient to the highest possible functional capacity, to teach them techniques that help them gain control of their breathing. Pulmonary rehabilitation can get somebody’s physical condition optimized so that they can better cope with their lack of lung function. A respiratory therapy program is an individually tailored, multi-disciplinary program for patients that will usually include not only the respiratory therapist, but maybe a nurse, physical therapist, occupational therapist, social worker-life skills people.

The key to pulmonary rehab is to consider it early in the disease and not wait until a patient has a really severe disease. You can get some lung function back, but you’re never going to return lung function to what was normal before.

What advice do you have for someone with advanced COPD?
I think that, first of all, if you’re a smoker, you better look at yourself in the mirror and say, "I need to do something about that." and physicians can help with that. There’s a lot of pharmacological support and smoking-cessation programs available for people.

If you’re a former smoker, you need to be really aware of the symptoms of COPD. Do you have shortness of breath? Do you have a cough? Do you get more short of breath than your friends? People need to be aware of these things and then talk to their doctors. Don’t accept a diagnosis without appropriate testing. Once the diagnosis is made, then learn all you can about the disease and get into pulmonary rehabilitation, if that’s appropriate.

My old medical director used to say, "COPD is dying one hard breath at a time." That’s not to say you can’t be hopeful, however, because you can slow the progression of the disease and people are recognizing it earlier. Make sure you seek out social support systems and demand good medical care, so that you can live as full a life as possible.